PROJECT BLUE BOOK

PROJECT 10O73 R:CORD
1. DATF. TIME GROUP 2. LOCATION
Jan - Mar 67 Petorson, Minn-sota
3. SOUECE 10. CONCLUSION
Civilian Other (Unreliable)
1. NUBER OBJECTS
One
5. LENGTH OF OBSERVATION 5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANAIY! 11. BRIEF SUMMARY AND ANAIY:
15-30 minutes 15-30 minutes SEE CASE FILE
f. TYPE OF OBSERVATION TYPE OF OBSERVATION
Ground Visual
7. COURSE
W-M.
$1. PHOTOS PHOTOS
51 Yos n Yos
No No
2. PHYSICAL EVIDENCE
t Yos
$y N$
FORM
ITD SEP 63 0-329 (TDE) Previoua editions of thle form may be usoi.
T

Jaw-Sax6s
other (inviliulle)
U.S. AIR FORCE TECHNICAL INFORMATION
This questionnaire has been prepared so that you can give the U.S. Air Force as much
information as possible concerning the unidentified aerial phenomenon that you have observed.
Please try to answer as y questions as you possibly can. The information that you give will
be used for research purposes, . Your name will not be used in connection with any statements,
conclusions, or publications without your permission. We request this personal information so
that if it is deemed necessary, we may contact you for further details.
1. When did you see the object? 2. Time of day: 4/ 15- 1
22 Hour Minutes
40
1167 (Circle One):1 A.M. or P.M.)
D=y Month Year
3. Time Zone:
(Circle One): a. o. Eastern (Circle One): a. (Circle One): Daylight Saving Daylight Saving
Central b! b. Standard
c. Mountain
d. Pocitic Pocitic
e. Otner
4. Where were you when you saw the object?
1i 1il C j
Nearest Postal Address Nearest Postai Address City or Town State or County State or County
(atal Duration
Hours Minutes Seconds
a. Certain c. Not very sure
b. Fairly certain d, Just a guess
5.1 How was time in sight determined? iv (/.. k -1 ivi
5.2 Was obieer in sight continuously?
6. What was the condition of the sky?
DAY NIGHT
a. Bright 11 a. Bright
b. Cloudy ,!1. b.Cloudy
(Circle One): a. In front of you d. To your left
b. In back of you e. Overheod
c. To your right f. Don't remember
FORM
FTD OCT 62 164 This form supersedes FTD 164, Jul 61, which is obsolete.

Page 2
IF you saw the object at NIGHT, what did you notice ce-cerning the STARS and MOON?
8.1 STARS (Circle One): 8.2 MOON (Circle One):
None a. Bright moonlight
b. A few b. Dull moonlight
c. Many (c) No moonlight - pitch dark
d Don't remember d. Don't remember ¸
9.What were the weather conditions at the time you saw object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky a. mrch i 1767
Hazy Fog, mist, or light rain
Scattered clouds c. Moderate or heavy rain
Thick or heavy clouds d. Snow
e. Don': remember
10. The object appeared: (Circle One):
c. Solid inl ,t d As a light 2,176%
b. Transparent e. Don't remember
c. Vapor
If it appeared as a light, was it brighter than the brightest stars? (Circle One): 1.If it appeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter c. Brighter c. About the same c. About the same
. Dimmer b. Dimmer d. Don't know
11.1 Comoare brightnass to some common object:
CA:
/
1.The edges of the abject were: 4.
(Circle One: a.Fuzzy or blurred c. Other
D b. Like c bright star cYanmlow
c. Sharply outlined
d. Dan't remember
.Did the object: (Circle One for eoch question)
a. Appear to stand still at any time? Yes, No Don't know
b. Suddenly speed up and rush away at any time? "Yes No Don't know
c. Break up into parts or explode? Yes No Don't know
d. Give off smake? Yes, No Don't know
e. Change brightness? Yes No Don't know
f. Change shape? Yes No Don't know
g. Flash or flicker? / Yes No Don't know
h. Disappear and reappecr? Yes No Don't know

Poge 3
14. Did the object disappear while you were watching it? If so, how?
cc h. 2 2.? (
.2 .s 1
1.Did the abject move behind something at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what
it moved behind:
Did the object move in front of something at any time, particularly a cloud?
(Circle One): Yes Don't Know. IF you gnswered YES, then tell what
in front of: .
17Tell in a few words the following things about the object:
b. Color snfl.. i y
18. We wish to know the angular size. old a match stick at arm's length in line with a known object and note how
much of the object is covered by the head of the match. If you had performed this experiment at the time of the
sighting, how much of the object would have been covered by the match head?
2.7 A O.
Draw a picture e: will show the shape of the object or objects. Label and include in your sketch any details
of the object tnat you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails.
Place an arrow beside the drawing to show the direction the object was moving.
1 1-19 rast Jan
Ba
fi w,
7 I 41
f
l.q..

yi
(Circle One) Yes) No)-1,
IF you answered YES, then how far away would you say it was?
22. Where were you located when you saw the object? Were you (Circle One)
(Circle One):
aIn the business section of a city?
á.Inside a building il 1 b.In the residential section of a city?
b. In a car c. In open countryside?
c. Outdoors d. Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. Other g. Other2/
24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions:
c. North c. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
24.2 ina ? miles per hour.
(Circle One) Yes No
25. Did you obsarve the object thraugh any of the following?
a. Eyeglasses No e. Binoculars Yes
b. Sun glesses No f. Telescope Yes No
c. Windsnield Yes g. Theodolite No
d. Windew giass Yes, No h. Other ∴. 1
In order that you can give as clear a picture as possible of what you saw, describe in your own words a common

Pag 5
. In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how
when you first saw it. Place a "B" on the compass where you last saw the object.
90° 75°
60
NU
E
-15° SW SW
S5 S6
28. Draw a picture that will show the mction that the object or objects made. Place an "A" at the begining of th
path, a '"3" at the end of the path, and show any changes in direction during the course. path, a 'B" at the end of the path, and show any changes in direction during the course.
fienlke
4 Cicee t. Meniith
2. IF there was MORE THAN ONE object, then how many were there?

Yes No
31.2 Please list their names and addresses:
7h bem Tlls 1j.
tul Tdid/ toak 1
Sat. :. 2sIu S1nn 1
1ih- 14Y 24
,
32. wing information about yourself:
NA
Noma First Name Middle Name
ADDRESS 1
Street City Zone State
j SoMe
TELEPHONE NUMBE "I SEX I1
Nrs
2i. Jhiclld WosS.
I W1 jhr ( K .t
!
( 141.1167 1.
Thie se d..
1. w.m th hes dsye
When and to whom did you report that you had seen the object?
-1 ) Lji 1. hirdih.
Day Month Year
26tcl 1hl.tTh
6.C2augh

Page 7
34. Date you comp this questionnaire: 71474 A 12
Day Month Yeor
qusstionnaire or a narrative explanation of your sighting.
- 1. s.:
71
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Page 8
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